1. Related Applications
This application is related to U.S. patent application Ser. No. 269,666, entitled "Everting Cannula Apparatus and Method", filed 1 Jul. 1994, the subject matter of which is incorporated herein by this reference.
2. Field of the Invention
The present invention relates generally to a method for grafting tissue at a target site, and specifically relates to endoscopic aortofemoral bypass grafting.
3. Description of Background Art
Prosthetic graft insertion from the abdominal aorta to the femoral vessels in the groin has become the standard method of direct surgical repair for aortoiliac occlusive disease over the past two decades. [See, Brewster, D.C., "Aortoiliac, Aortofemoral, and Iliofemoral Arteriosclerotic Occlusive Disease", in Haimovici, H. (ed.), Vascular Surgery: Principles and Technique (Appleton & Lange, 1989)]. The method is used in over 90% of such patients by most vascular surgeons. Present techniques for performing aortic reconstruction include open surgical bypass via an abdominal approach, a retroperitoneal approach, or infrequently, an endovascular approach, using a stented graft introduced through an incision in the femoral artery.
The open surgical approaches, either transabdominal or retroperitoneal, require large abdominal or flank incisions, approximately 20-30 cm in length for exposure and manipulation of the aorta. In this procedure, the aorta is cross-clamped for a period of time, which may increase the potential of ischemia to the kidneys or bowel. The postoperative recovery period is prolonged as a result of such trauma to the patient's organs and system. Laparoscopic approaches, using small incisions and rigid endoscopes to visualize inside the abdomen for the aortic anastomosis may be used and are known in the art. The laparoscopic technique requires multiple incisions, for example 4-5 incisions varying between 1-4 cm in length each. In addition, the laparoscopic technique requires multiple retractors to control and displace the bowel to enable access to the aorta. Aortic cross-clamping is required, and suturing the aortic anastomosis is difficult, increasing the cross-clamp time. The operative time is prolonged using this approach due to the difficulties associated with bowel retraction.
The most recent technique is the endovascular approach, which does not require abdominal incisions, since the graft is introduced via a groin incision and a femoral artery cutdown. Aortic cross-clamping is not required with this approach. The stented grafts used in practicing this technique are large in diameter, and graft introduction is only possible in patients with large, undiseased femoral arteries. Metal stents or anchors used to secure the proximal aortic end of the graft may not hold the graft properly, leading to graft migration. Alternatively, the metal stents or anchors may work their way through the wall of the aorta, causing aortic perforation and death.
Thus, there remains a need for a less invasive technique for performing aortofemoral bypass grafting that decreases the trauma to a patient's system and organs and the concomitant recovery time.